It was first used in medicine over a hundred years ago. It was readopted in ophthalmology in the 1960's and has become more widespread in its applications. Its cosmetic uses were discovered by chance in the late 1980s. It is currently licensed in the UK for cosmetic use on the brow and for medical use and has been used as such for over 30 years. It has been used in aesthetic medicine in the USA for many years. More recently, France has allowed its cosmetic use.

Is Botox® safe?

As Botulinum toxin is one of the most powerful neurotoxins known to man, it is naturally surprising to learn that it can have any beneficial effects. Interestingly, it is not the first time that people have used minute amounts of toxic substances for cosmetic reasons. Italian ladies used belladonna hundreds of years ago to make eye pupils larger. Botox® is purified and used in very small quantities. It cannot produce any permanent damage or travel within the body to make you ill. It attaches to the muscles it is placed in and can not migrate from there. The injection technique ensures that it cannot be passed in to the blood stream. The toxin is the same one that causes food poisoning, but used in very, very much smaller quantities. Botox® is a prescription only drug that has to be written up by a medical professional (a doctor or dentist). Prescription only drugs cannot be advertised and this is why you will not find any information sheets in the waiting room!.

How does it work?

When Botulinum toxin is injected into target muscles it temporarily puts them to sleep for 3 to 4 months. Botox® has great effect in areas in which "dynamic" wrinkles are produced by continual creasing. The facial skin overlying the target muscle will appear much smoother and relaxed. It can soften wrinkles that are there at rest, as skin has a chance to repair, but cannot erase these static lines. Probably, most desirable, is its ability to stop any worsening of wrinkles.

What areas can it be used to treat?

The upper third of the face is where the best results are obtained: the crows' feet, the upper forehead and the brow. Botulinum toxin can also be used to lift eyebrows position by a few millimetres, to soften dimply chins and horizontal neck lines. Careful use will produce reduction in the stringy vertical bands and horizontal lines in the neck.

The Treatment

After cleaning the area, anaesthetic cream will be applied. Careful measurements will be made and I will ask you to repeatedly frown or squint. Small amounts will be injected with micro fine needles. I like to see and document your results after two weeks so that the regime can be improved if necessary.

The down side?

• Bruising may occur. This is not very common but more likely around the eyes.
• Slight redness.
• Headache, particularly with forehead procedure.
• Rarely; nausea, distant muscle tremors or a 'flu like illness.
• Botox® contains a small amount of human albumin that is collected from pooled blood donations in the United States. Particular care is taken with the control of donors, the manufacturing process and the removal or inactivation of any viral contamination. There is a theoretical risk of virus transmission, but none has ever been reported.

What could go wrong?

• Drooping eyelid (this can happen with forehead treatment): The drooping is caused by weakness of the muscle holding up the eyelid. This happens in less than 1% of patients and will disappear over a period of 2 - 10 weeks. It is treatable with eye drops. It can be due to travel of the injected solution and can be reduced by keeping strictly to the after care instructions.
  
  
• Drop in eyebrow position (this is specific to horizontal forehead lines treatment): Some patients and most men, due to their heavier brows, are not candidates for treatment of the upper forehead. If it occurs, it is only temporary but can take 10 weeks to go.
  
  
• Double vision (this is generally specific to crows' feet treatment). This can be due to tracking of injected solution. The problem will probably only last a couple of weeks but is not treatable and will mean you can not drive.
  
  
• "Spock or Diablo" brow (generally specific to horizontal forehead lines treatment). An asymmetric elevation of one eyebrow tail is again rare. It may be due to tracking of solution, so take care with post op instructions.
  
  
• It is thought that high doses and frequent top ups can lead to developing a resistance to Botox® and it no longer works as effectively. For this reason, it is advisable to have all areas you require treated at one sitting.

What to do after treatment:

• Try to remain upright for 4 hours afterwards (no yoga classes or shoe shopping!).
• Do not touch the area for 12 hours, even after that, work away from eyes and up from the brows when cleansing etc.
• No air travel for at least 24 hours.
• No facial massage for a week.
• For the first few hours, work your face by frowning and smiling! This helps the treatment to work by speeding the absorption of Botox®.
• Wait for up to two weeks for the treatment to work.
• It is a good idea to attend the clinic for a follow up visit and face mapping after your first treatment. This is entirely for recording purposes in order to tailor the treatment and adjust the dosage to your optimum level.

Who should not have treatment:

• Pregnant, breastfeeding or trying for a baby.
• Patients who have any diseases that affect muscle activity, (history of Bells Palsy, Myenasthenia Gravis, Multiple Sclerosis)
• Bleeding disorders or those taking drugs that affect bleeding time (warfarin, heparin, aspirin, glucosamine).
• Drugs that may interact with Botox® (aminoglycoside antibiotics, spectromycin, quinine sulphate) It is also probably safest to avoid Botox® usage whilst taking antimalarial quinine based drugs too, although an interaction is only a theoretical problem.
• Surgery or active infection in the area.
  

Cost of treatment:

Botox® is charged per unit. An average price is £200 for one area in a female. One area can be defined as the crows' feet or the vertical frown line between the eyebrows or the horizontal forehead lines. Two areas are charged at £250 and 3 areas at £300.

It is worth knowing that men, with heavier musculature, especially across the brow, will probably require higher (and therefore, more expensive) amounts of the drug.